What do you do when an older patient has no mal-absorption symptoms but a low fecal elastase-1? Well a new study says that you should go ahead and provide support. They concluded that older adults with low elastase-1 enzyme levels might benefit from pancreatic enzyme supplementation therapy, regardless of the amount of steatorrhoea, mal-digestion or clinical symptoms.
Yes, fecal elastase-1, like everything else decreases with age. The study found that 21.7% of subjects age 60 and over had a pancreatic elastase-1 level < 200 μg/g, compared to < 1% of 20 to 29 years old controls. The study didn’t find a correlation between fecal elastase-1 levels and clinical symptoms of abdominal discomfort, though it did conclude that relevant mal-digestion may occur earlier than the appearance of overt symptoms. Your patient may not feel bad but may be silently mal-digesting food with a decline in nutrient absorption.
Maybe older adults should get a pancreatic check along with, mammograms, cholesterol and colonoscopies, all the fun stuff older adults get to do. Remember, enzyme supplementation will not interfere with elastase-1 testing results, and elastase-1 is generally lower in vegetarians and vegans because protein stimulates its release. The study was, Fecal pancreatic elastase-1 levels in older individuals without known gastrointestinal diseases or diabetes mellitus. BMC Geriatr. 2011 Jan 25;11:4.
~ Dr. Elizabeth Redmond